Prevalence and factors associated with pulmonary tuberculosis among children 5-15 years attending six health centres in Kampala city

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Abstract

Introduction: Uganda is 19th of 22 high TB burden countries yet childhood TB is neglected; lagging TB contact tracing, poor recording and reporting with notification mainly based on smear results. With the high burden of adult TB and HIV in Uganda, the burden of TB in children is expected to be high but there is paucity of good quality data and uncertainty in actual prevalence of childhood TB in Uganda.
Objective: To determine the prevalence and factors associated with pulmonary Tuberculosis among children attending primary health care facilities in Kampala.
Methods: A cross-sectional study among 255 children 5 to 15 years, attending 6 primary health care facilities between February and April 2015. Data was collected using a questionnaire including the following information; socio-demographics, clinical history and examination; chest x – ray results, HIV serology, smear positive TB based on sputum using smear ZN or FM staining techniques; and Gene xpert analysis of two samples. Smear negative TB was diagnosed clinically based on the algorithm from a Desk Guide under evaluation. HIV was tested as per the national HIV rapid testing algorithm. The data was entered in Epidata software, and exported to stata for analysis. Multivariable logistic regression was used to identify the associated factors, whilst the WHO. Anthro-plus was used for analysis of nutritional status.
Results
The overall prevalence of PTB was high at 13.7 % (95% CI: 2.6 – 24.8). This prevalence varied among the HIV positive (41.7%), malnourished children (21.7%) and children with a history of contact (89.3%). Factors that influenced PTB included: tobacco smoker at home (OR = 1.6, 95 % CI: 1.07 – 6.86), stunting (OR = 2.2, 95 % CI: 1.01 – 4.15). Only 1/19 (5.3%) of the clinically diagnosed PTB children and 13/16 (81.3%) of the microbiologically confirmed PTB children were initiated on treatment within a month of diagnosis.
Conclusion
There is a high prevalence of pulmonary tuberculosis among children in Kampala more-so in HIV positive, malnourished and those with history of TB contact. There is need to lay strategies to lower malnutrition, fight HIV among children, and intensify contact tracing so as to boost the fight against childhood tuberculosis